Provider Demographics
NPI:1275369415
Name:IMANI TRANSPORT
Entity type:Organization
Organization Name:IMANI TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER GENERAL
Authorized Official - Prefix:
Authorized Official - First Name:TREVIS
Authorized Official - Middle Name:LUMBU
Authorized Official - Last Name:KALUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-693-7990
Mailing Address - Street 1:320 GAS LIGHT RD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-7049
Mailing Address - Country:US
Mailing Address - Phone:465-300-1405
Mailing Address - Fax:
Practice Address - Street 1:320 GAS LIGHT RD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-7049
Practice Address - Country:US
Practice Address - Phone:465-300-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)